Media Exposure and Acute Stress Following the Boston Marathon Bombings

E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.

Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).

These findings, and those of other post-9/11 studies, challenge what many experts suggest—that indirect media-based exposure to trauma is not clinically relevant for the general public. Indeed, the American Psychiatric Association definition makes clear that only individuals who directly experience trauma—or whose close loved ones directly experience trauma—are considered to have been “exposed” to trauma. Without this “exposure,” the acute stress or PTS symptoms experienced by an individual are not considered particularly meaningful for overall well-being. While studies have examined how therapists and emergency response workers respond to indirect trauma exposure through their professional duties, there has been little interest in studying whether mass media coverage of a major collective trauma unintentionally spreads the negative impacts beyond the directly affected communities.

“Traditional media warn us about the gruesome nature of an image before showing it; social media typically display such images without warning.”

The relevance of indirect media exposure became apparent again after last April’s Boston marathon. In the days following the marathon bombings, my University of California, Irvine colleagues and I decided to replicate our 9/11 study and examine the impact of media exposure to the Boston Marathon bombings. We sought to look at all types of media: how much TV people watched, their exposure to disaster-related radio, print, and online news, and their use of social media like Facebook, Twitter, YouTube, and Vimeo in the week following the bombings. We were especially interested in responses to social media coverage. Unlike traditional media that warn us about the gruesome nature of an image before showing it to us, social media typically display such images without warning.

We also wanted to compare responses to direct vs. indirect media exposure to the bombings—were these different ways of being “exposed” tied to more or less acute stress?

Two weeks after the bombings, we launched another web-based study with more than 4,600 people from all over the country—including nearly 850 people who were in Boston on the day of the bombing. As we expected, both direct exposure and indirect media exposure were linked to acute stress symptoms. However, the people who consumed lots of bombing-related media in the week after the bombings (six or more hours per day) were six times more likely to report high acute stress than those who were at the Boston Marathon. That is, indirect media exposure was associated with a wider range of acute stress-related symptoms—flashbacks, feeling anxious, wanting to avoid reminders of the bombings, etc.—than direct exposure to the bombings. Even when we took into account pre-existing mental illness or TV-watching habits that might draw people into media coverage, our findings did not change (Holman, Garfin, Silver, 2014).

“People who consumed lots of bombing-related media in the week after the bombings were six times more likely to report high acute stress than those who were at the Boston Marathon.”

What explains this? I suspect that the repetitive nature of media coverage (cycling the same images over and over during a story) may keep the event—and the feelings associated with it—alive for some people. In contrast, people directly exposed to an event may experience a sense of closure and relief once the bombs stop exploding and the acute threat has ended. Seeing the same disturbing images over and over on television (or on social media) may repeatedly trigger fears and worry in some people and make it difficult for them to move on from the event.

Nonetheless, not everyone who consumed lots of media coverage of the Boston Marathon bombings reported high numbers of acute stress symptoms. If we can identify those people who are most affected by media, we can reach out to them early and try to prevent them from overexposure to media coverage. Indeed, soon after the bombings, the Red Cross put signs up in Boston urging people to limit their exposure to television coverage of the bombings. I think that’s good advice for all of us—we should be safe from harm as we follow what’s happening in the world.

We are just beginning to understand the role of the media in shaping our early responses to collective trauma and spreading acute stress beyond the affected area. We need to do more to figure out how best to protect people who might be vulnerable to the negative impact of media exposure in the aftermath of disasters.

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